Posts Tagged ‘Community First’

Where’s the beef in Community First?

October 25, 2011 6 comments

We’ve long maintained that the Patrick administration’s agenda of phasing down and closing state developmental centers would ultimately fail to free up additional funding for the community based system.

It’s been nearly three years since the administration announced its plan to close the Fernald, Templeton, Monson, and Glavin Centers and reportedly plow back as much as $45 million a year in the “savings” into beefing up the largely privatized community-based system of care.  That $45 million savings projection was a cornerstone of the administration’s “Community First” initiative.

So far, the administration has succeeded in moving hundreds of residents out of developmental centers, starting with Fernald, which is now emptied of all but 14 of  its residents, who have filed appeals of their transfers.  But nothing remotely close to the $45 million in savings has materialized.  In fact, the opposite has been the case — the administration has continued to cut community-based line items in the Department of Developmental Services budget.

In a November 20 email to members and other advocates, the Association of Developmental Disabilities Providers, which has wholeheartedly supported the closures of the developmental centers, stated the following :

For the last four fiscal years, in order to cope with the effects of the economic collapse of 2008, the Commonwealth’s budget has:

  • deeply cut Family Support programs, leaving 10,000 families without service,  
  • inadequately addressed Chapter 257 rate reform by not introducing sufficient funding to rate making but instead forcing existing programs to redistribute already inadequate funding
  • failed to address historically low salary needs of the community workforce (though the Legislature has recently added the first salary reserve dollars in four years)
  • continued to require community programs to implement state mandates without sufficient funding, including closing sheltered workshops without funding to replace this model in favor of a more inclusive and empowering model.
  • not backed it’s professed interest in Community First and Employment First with funding to make these efforts successful. (my emphasis)

Not exactly a ringing endorsement of the success of the administration’s community-based care delivery model and its promised use of of the savings from the developmental center closures.  We hope the ADDP and the Arc of Massachusetts will reach the next logical step in their argument and urge the administration to cease and desist from closing the centers.

Unfortunately, the ADDP and the Arc of Massachusetts are supporting H.984, known as “The Real Lives Bill,” which appears to continue to rely on the premise that DDS clients should not be given the choice of living in developmental centers.

The bill, sponsored by Rep. Tom Sannicandro,  is intended to provide for more choice for persons with intellectual disabilities.   But it appears to specifically deny consumers the choice of “congregate services.”  In other words, everyone should have a choice, as long as they choose only small, community-based settings.  We believe, however, that the congregate services provided by developmental centers are appropriate for certain people who are unable to benefit from community based care.  And now we’re seeing that closing the congregate care centers is not freeing up community-based funding.

Sannicandro’s bill does appear to recognize that the community-based system has not thus far benefitted from the developmental center phase-downs.  The bill’s text reads:

Too many people are not receiving the assistance they need. The public Medicaid system is reeling from cost pressures. The time has come for individuals with disabilities, families, advocates and providers to work together with policy makers in the administration and legislature in crafting a support system that both increases quality and on average reduces costs whenever possible.

We agree with the language in Sannicandro’s bill on that last point.  We just disagree that closing the developmental centers is the right way to go about it.

Update on our requests for cost records

September 16, 2011 3 comments

After a month and a half, it’s troubling that the Patrick administration is apparently still unable to locate cost records we requested pertaining to a single community-based group home contract.

I just received a letter from the Department of Developmental Services, dated September 14, that they are in the process of searching for the documents, which I had requested on July 29.   Meanwhile, the MassHealth Privacy Office in the Executive Office of Health and Human Services has been searching for these same records since August 9.

To recap, we’ve been trying to find out the sources of state funding for medical, nursing, clinical, and therapeutic services in a single DDS group home program run by the May Institute, a private provider.  We have a copy of a $1.2 million contract with the May Institute, which provides for 24-hour residential services under the program for 14 individuals in four residences in the DDS Central Middlesex Area.

The FY 2009 contract, however, only provides for direct care and limited nursing services for the 14 residents.  It does not mention medical, extended nursing, clinical or therapeutic services.

From what we’ve been able to determine, the administration has been basing its $20 million annual cost savings estimate in closing the Templeton, Monson, and Glavin Developmental Centers on a comparison of their budgets with the cost of community-based group contracts such as the May Institute contract.  But here’s the rub.  Our understanding is that the Templeton, Monson, and Glavin budgets do provide for medical, extended nursing, clinical, and therapeutic services. 

Naturally, the community system will appear to be less expensive than the developmental centers if certain community-based costs are not taken into account.  That’s why we want to find out exactly how much is being paid to fund those additional services to which the May Institute residents are reportedly entitled, and where that money is coming from.

By the way, we originally asked DDS on July 7 for the budgets of the Monson, Templeton, and Glavin Centers.   A month later, we received a one-page document from the department with single, line-item amounts representing the total annual spending for each facility.  There was no budgetary breakdown whatsoever for the facilities.

We appealed to the state’s Public Records Division for help, explaining that a budget of a state facility involves more than just a single line item.  As a result, I received a second letter from DDS, also dated September 14, stating that the department was in the process of searching for the “additional (budgetary breakdown) information” I had requested. 

I guess DDS considers a budget and a “budgetary breakdown” to be entirely separate concepts.  Stay tuned.

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